Pre-Existing
Condition Medical
Insurance Program
Health Reform and People with
Pre-Existing Conditions
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The Pre-Existing Condition Insurance
Plan makes health insurance available to people who have had a
problem getting insurance due to a pre-existing condition.
PCIP, which is administered
by either your state or the U.S. Department of
Health and Human Services, provides a health
coverage option if you have been without health
coverage for at least six months, you have a
pre-existing condition or have been denied
health coverage because of your health
condition, and are a U.S. citizen or reside here
legally.
The Program:
- Covers a broad range of health
benefits, including primary and specialty care, hospital
care, and prescription drugs. All covered benefits are
available to you, even to treat a pre-existing
condition.
- Doesn’t charge you a higher
premium just because of your medical condition.
- Doesn’t base eligibility on
income.
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The Pre-Existing Condition Insurance Plan covers a
broad range of health benefits, including primary and specialty care,
hospital care, and prescription drugs. All covered benefits are
available for you, even to treat a pre-existing condition. |
Question:
Who is eligible for
Pre-Existing Condition Insurance Plan?
Answer:
To be
eligible for the Pre-Existing Condition Insurance Plan,
- You must be a citizen or
national of the United States or reside in the U.S. legally.
- You must have been without
health coverage for at least the last six months. Please
note that if you currently have insurance coverage that
doesn’t cover your medical condition or are enrolled in a
state high risk pool, you are not eligible for the
Pre-Existing Condition Insurance Plan.
- You must have a pre-existing
condition or have been denied coverage because of your
health condition
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- Click the
"Application Form" link below to download a PDF
version of the enrollment application.
- Fill out
the application by following the instructions in the
application and make copies of any required
documents. Remember to include a copy of one of the
following documents:
- A letter from a doctor,
physician assistant, or nurse practitioner dated
within the past 12 months stating that you have
or had a medical condition, disability, or
illness. This letter must include your name and
medical condition, disability, or illness and
the name, license number, state of licensure,
and signature of the doctor, physician
assistant, or nurse practitioner.
- A denial letter from an
insurance company licensed in your state for
individual insurance coverage (not health
insurance offered through a job) that is dated
within the past 12 months. Or, you may provide a
letter dated in the past 12 months from an
insurance agent or broker licensed in your state
that shows you aren’t eligible for individual
insurance coverage from one or more insurance
companies because of your medical condition.
- An offer of individual
insurance coverage (not health insurance offered
through a job) that you did not accept from an
insurance company licensed in your state that is
dated within the past 12 months. This offer of
coverage has a rider that says your medical
condition won’t be covered if you accept the
offer.
- If you are under age 19
OR if you live in Massachusetts or Vermont, an
offer of individual insurance coverage (not
health insurance offered through a job) that you
did not accept from an insurance company
licensed in your state that is dated within the
past 12 months. This offer of coverage must show
a premium that is at least twice as much as the
Pre-Existing Condition Plan premium (the monthly
payment you make to an insurer to get and keep
insurance) for the Standard Option in your
state. To find out if the premium you were
offered but did not accept is twice as much as
the premium in the Pre-Existing Condition
Insurance Plan for the Standard Option in your
state, check out the
State Plans page.
What is GEHA?
Government Employees Health Association (GEHA) currently
contracts with the federal government to provide health
plans and dental plans to civilian federal employees and
retirees. Founded as a health plan for railway mail clerks
more than 70 years ago, GEHA now provides benefits to more
than 1 million covered lives worldwide. The company has
experience with multiple government contracts and
significant expertise in provider networks, pharmacy
benefits, managed care and health information technology.
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In a rush?
Call 800.874.9191 for an immediate quote. |
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